FFRguided

FFR-guided refers to the use of fractional flow reserve measurements to inform decisions about coronary revascularization in patients with suspected or known coronary artery disease. FFR is an invasive physiologic index obtained during coronary angiography by advancing a pressure-sensing wire across a coronary stenosis and measuring the ratio of distal coronary pressure to aortic pressure during maximal hyperemia, usually induced with adenosine. The resulting value is a dimensionless number, with lower values indicating more significant impairment of blood flow. A commonly used threshold is 0.80; lesions with FFR ≤ 0.80 are considered hemodynamically significant and may benefit from PCI, while lesions with FFR > 0.80 are typically managed with medical therapy alone.

In clinical practice, FFR is used to determine whether to perform percutaneous coronary intervention on a given lesion and to refine strategies in multivessel disease. It is particularly helpful for intermediate-grade stenoses observed on angiography and for distinguishing lesions that will benefit from intervention from those unlikely to. FFR-guided decision making aims to reduce unnecessary stenting and to optimize patient outcomes by focusing revascularization on lesions with demonstrable functional significance.

Evidence from randomized trials and subsequent analyses has supported its use. The DEFER trial showed that deferring PCI for lesions with favorable FFR values yields outcomes similar to immediate PCI. The FAME trials demonstrated that FFR-guided PCI for multivessel disease reduces unnecessary stenting and improves certain outcome measures compared with angiography-guided planning, though effects on mortality and myocardial infarction vary by study and population.

Limitations include the need for invasive catheterization, reliance on hyperemia, potential measurement drift, and reduced applicability in certain microvascular conditions.